Laserfiche WebLink
r <br />� ,„,,,�, APPLICATION FGA <br />CONSTRUCTION <br />everett PERMIT <br />TO BE COMPLETED IN BLACK INK - PLEASE PRINT <br />BUILDING DEPT. <br />259.8745 ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL <br />❑ PLUMBING ❑ SIGN <br />[IY YryU'1[ <br />('./1AA'1F c C. /AAA's) 2- 4/,Y J NOA✓f" "' 4r",C QPY.2 — <br />ARCHITECT OR DESIGNER <br />MAILADDRESS <br />CITY <br />ZIP <br />PHONE <br />--- N. /f, <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE <br />N. d . <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE A <br />II <br />k , A. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />LICENSE• <br />n' <br />_ /V, A <br />CUSS OF WORK <br />❑ ❑ <br />r-�� / <br />0 <br />❑ ❑ <br />❑ <br />NEW ADDITION <br />ALTERATION C7 REPAIR <br />DEMOLITION <br />WOODSTOVE/FRPL.INSERT <br />BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />�.� <br />_ OUO <br />4 <br />)0 <br />DESCRIBE DESCRIBE WOPK <br />JPF�U/P,Q/.S/7, <br />ron APB. <br />USE OF BUILDING <br />- <br />1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP' <br />PLICATIONAND KNOWTHE SAME TO BE TRUEANDCORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE- <br />IN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />LEGAL OESCRIPTIONOFPROP RTY(SHOWNBELOW OR ATTACH FOUR COPIES) <br />LOT— BLOCK_OF_ <br />_ ,75 4,- �CJ/ �3,1 <br />Ao id r y <br />PROJECT ADDRESS <br />APPLIMNTS CITY BUSINESS LICENSE NO. <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />NO. <br />TYPE OF EO IPIf MEWT <br />FEE <br />WATER CLOSET (TOILET) <br />AIR COND. UNITS-H.P. EA <br />BATHTUB <br />REFRIGERATION UNITS-H.P, EA <br />/ <br />LAVATORY (WASH BASIN) <br />01 <br />BOILERS-H.P. EL. <br />SHOWER <br />GAS FIRED AC, UNITS -TONNAGE EA <br />KITCHEN SINK B DISP. <br />FORCED AIR SYSTEMS-B.T.U. M EA. <br />_ <br />DISHWASHER <br />WALL HEATERS-B.T.U. M <br />_ <br />LAUNDRYTRAY <br />UNIT HEATERS-B.T.U. M <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C.F.M. <br />VACUUM BREAKERS <br />I <br />ISTOVE <br />ROOF DRAINS-RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK SERVICE -BAR, ETC. <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL S <br />PERMIT ! <br />PERMIT $ <br />_ <br />TOTAL FEE • <br />TOTALFEE 3 <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL <br />SETBACK I REAR SETBACK I SIDE SETBACK <br />USE ZONE ILOI AREA I VACANT SITE <br />DYES ONO ie <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF DWELLING UNIT9 <br />PLANS CHECKED BY <br />PLAN CHECK FEE <br />FEE IRECEIPT NO <br />FEES I VALUATION I FEE <br />BUILDING <br />S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />PENALTY <br />BY <br />TOTAL <br />